The Many Faces of Pediatric Acne: A Practical Algorithm for Treatment, Maintenance Therapy, and Skincare Recommendations for Pediatric Acne Patients

June 2023 | Volume 22 | Issue 6 | 539 | Copyright © June 2023


Published online May 25, 2023

Lawrence A. Schachner MD FAAD FAAPa, Anneke Andriessen PhDb, Latanya Benjamin MD FAAD FAAPc, Madelyn Dones MD FAAPd, Leon Kircik MD FAADe, Ayleen Pinera-Llano MD FAADf, Adelaide A. Hebert MD FAADg

aDepartment of Dermatology and Cutaneous Surgery, Department of Pediatrics,
Leonard M. Miller School of Medicine, University of Miami, FL
bRadboud UMC, Nijmegen and Andriessen Consultants, Malden, The Netherlands
cDepartment of Women's and Children's Health, Florida Atlantic University, Boca Raton, FL
dBaptist Health Hospital and Nicklaus Childrens' Hospital, Miami, FL
eIcahn School of Medicine, Mount Sinai, New York, NY; Indiana University Medical Center, Indianapolis, IN;
Physicians Skin Care, PLLC, Louisville, KY; DermResearch, PLLC, Louisville, KY
fKing Bay Pediatrics and Nicklaus Children's Hospital, Miami, FL
gDepartment of Dermatology and Pediatrics, McGovern Medical School, and Children's Memorial Hermann Hospital, Houston, TX

Abstract
Background: Pediatric acne is a common, complex, multifactorial inflammatory skin disease with various expressions in childhood that can be categorized by age, severity, and pubertal status.
Methods: The Faces of Pediatric Acne Project (FoPAP) aims to improve patient outcomes. The FoPAP group developed an algorithm that follows a consensus paper and a clinical case series on pediatric acne by applying the selected literature and drawing from the clinical knowledge and experience of each group member.
Results: The algorithm addresses neonatal, infantile, mid-childhood, preadolescent, and adolescent acne and starts with education on acne, general measures for prevention, treatment, maintenance, and ongoing skin care. Evaluation of pediatric acne requires a directed medical history and physical examination. For mid-childhood acne patients, a workup is warranted, and endocrine-associated abnormalities necessitate referral to a pediatric dermatologist. The second section of the algorithm identifies the type of pediatric acne, followed by the third section on acne treatment using a prescription or nonprescription treatment and skincare options. After successfully controlling the disease, maintenance treatment with topical agents and skincare using gentle cleansers and moisturizers containing lipids such as ceramides is important.
Conclusions: The pediatric acne algorithm offers a comprehensive approach to treating and maintaining pediatric acne. In addition, it may support healthcare providers to bring more attention to pediatric acne patients and improve outcomes.

Schachner LA, Andriessen A, Latanya Benjamin L, et al. The many faces of pediatric acne: a practical algorithm for treatment, maintenance therapy, and skincare recommendations for pediatric acne patients. J Drugs Dermatol. 2023;22(6):539-545. doi:10.36849/JDD.7440 

INTRODUCTION

Acne vulgaris (acne) is a multifactorial skin disease with a prolonged course of acute outbreaks, relapses, and recurrences with significant social, psychological, and physical consequences.1-6 The presentation of pediatric acne depends on age (neonatal, infantile, mid-childhood, preadolescent, and adolescent), severity (mild, moderate, severe), type (eg, comedonal, papules, pustules, nodular), and other characteristics (eg, oily skin).5-8 Discoloration, such as post-inflammatory hyperpigmentation (PIH) and scar formation, may occur in some patients, making it necessary to initiate timely and effective treatment.9,10

Triggered by a pattern of innate inflammation, pediatric acne may manifest underlying pathology.5,6 Workup, when necessary, is based on age and physical findings, including morphology and distribution of acne lesions and age-related physical conditions.5,6,10

The pathogenesis of acne is thought to be similar at all ages, including pediatric acne.5,6,10-18 However, treatment and maintenance may differ due to the state of skin maturity and concerns about the safety and efficacy of various therapies in young age groups.5,6,10-18 
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